The Collective Action Problem: The Case of America's Uninsured

Submitted by Sina Odugbemi On Mon, 04/20/2009

Numbers alone do not confer strength, and if that can happen in an advanced democracy just imagine how tough it is to make numbers count in a poor, developing country. The case in point is the plight of the 50 million Americans without health insurance. According to a recent report [No strength in numbers of America's uninsured], [1]it remains very difficult for these 50 million citizens to turn their frustration into political action. Here is why:

These are isolated citizens; they are not an organized force.

Unlike farmers and other organized groups, they cannot help legislators who decide to help them. The legislators face picking up a fight with vested interests without any muscle behind them.

The cost of participation is deemed too high for many of the uninsured: they are too busy scrambling to make ends meet to become political activists. As a friend of mine used to say, you need a full stomach to engage in political action. Hungry people do not sustain political action.

Public opinion sees the problem of health care as a personal issue. That means the framing is episodic, not thematic. Americans apparently believe the issue is affordability not universal coverage. That frame has political consequences. It means a lot of work needs to be done to build the case for universal coverage; otherwise, it is not likely to happen.

The sum: as an expert quoted in the report says 'It certainly has been a concern out of our history that unorganized voices aren't heard'.

And that is the point: unorganized voices are not heard. There are many reform initiatives being launched around the world, and they would benefit the vast majority of citizens, but because those citizens are not able to act collectively the initiatives fail, or are rolled back. All this is why all those who care about pro-poor social and political change should worry about solving the context-specific collective action problem. It is usually there in one shape or the other.